INSIDE THE ISSUE
Spilka and Mariano: Chapter 224 Deserves to Be Revisited
Chapter 224 of the Acts of 2012 – the sweeping healthcare reform law that created the Health Policy Commission, the cost growth benchmark concept, and numerous other provisions that have guided the commonwealth’s healthcare system for a decade – needs to be revisited and reassessed, according to Senate President Karen Spilka and House Speaker Ron Mariano.
The two legislative leaders made their comments during a joint interview last Wednesday with the State House News Service’s Katie Lannan.
“It’s aways a good idea to take a look at these things years later to see were we on target, did the law accomplish what we wanted it to accomplish. Do we need to tweak it? What do we need to do?” Spilka said when asked about the market oversight aspects of Chapter 224.
Mariano pointed to prescription drug costs as another area that Chapter 224 did not address adequately.
“224 was done 10 years ago … and 10 years is a long time,” Mariano said. “We never charged the [Health Policy Commission] with factoring prescription drugs and pharmaceuticals into the medical expenditure number. We need to make some changes in 224. It is time.”
MHA’s President & CEO Steve Walsh, who chaired the House’s Committee on Health Care Financing during the creation of 224, has voiced the healthcare community’s continued support of a cost growth benchmark, but also its concerns with the sustainability of the current law, especially as it relates to the benchmark. The HPC in any particular year uses two-year old data to set the benchmark for the following year, in effect ignoring the experiences of providers during the current year. This discrepancy is especially notable this year as the HPC considers the benchmark for FY2023; missing from its calculations is data from the transformational, once-in-a-century, financially destabilizing pandemic. Hospitals have called on the legislature to revisit 224 and modernize the benchmark to ensure its success through the coming decade. MHA also endorses a review of the HPC’s board makeup to move it away from an essentially academic commission to one that reflects the real-world experiences of healthcare operations.
One Particularly Important Amendment
Last week the State Senate engrossed a supplemental spending bill, adding a number of amendments that the healthcare community supports. One, if it is preserved in the conference committee with the House, will have an immediate beneficial effect on helping to resolve the greatest current pressure point in the healthcare system – workforce shortages.
Amendment 42 sponsored by Sen. Julian Cyr (D-Truro) would extend the authorization for senior nursing students in their last semester, or students who have been graduated from nursing school but haven’t yet received their licenses, to practice nursing in an inpatient setting. That flexibility was granted by emergency order during the outset of the pandemic and was extended by legislation in June 2021. Cyr’s amendment would allow the nursing students/graduates to practice for 180 days after the Public Health Emergency expires, which some are speculating may occur in July 2022.
Healthcare organizations and nursing schools embraced the flexibility, stressing that it is a critical component to sustaining the nursing pipeline. It allows needed workers to begin work and it helps the new nurses hit the ground running in their professions. Of course, the law requires proper supervision of the recent graduates. MHA members say fast-tracking new nurses into caregiving positions via supportive transition programs is great for workforce development; it allows the new grads to begin gaining experience as they navigate the challenging scheduling issue of the NCLEX exam and the oftentimes administratively burdensome licensing process.
$4K-Per-Employee Grants May Jumpstart Hiring
Governor Baker last week unveiled the HireNow program that provides employers (including non-profit employers) with $4,000 per employee to be used to cover training costs or as a signing bonus for new employees. The goal is to fill the many open positions across the commonwealth by giving employers the means to quickly hire workers. Hires must be made after March 23, 2022, be retained for a minimum of 60 days, and be placed in jobs that are at least 30 hours per week. New hires must be Massachusetts residents employed in Massachusetts and must receive at least $14.25/hour, and no more than $42.50/hour (or approximately $85K annually). There is a limit of $400,000 per employer and the grants, funded through $50 million from the American Rescue Plan Act, will be provided on a first-come, first-served basis. Learn more through the state’s HireNow website.
State Budget Request: Invest in Telehealth Patient Navigators
The COVID-19 pandemic illuminated the benefits of telehealth as a way of providing safe, convenient, and efficient access to healthcare. Still, many individuals and communities in Massachusetts struggle accessing telehealth care due to broadband affordability issues and digital fluency. Metropolitan Area Planning Council research indicates that approximately 20% of households in Gateway Cities lack internet access at home. Another 30% of households lack access to computing devices. While federal broadband subsidy programs exist, adoption of these programs has been significantly low, due in part, to linguistic issues and administrative burdens. Concurrently, healthcare providers say no-show rates among telehealth patients disproportionately reflect non-native English-speaking patients and patients of color.
MHA in its recent budget advocacy at the State House says trusted patient navigators – that is, community health workers and social workers, who are demographically reflective of their communities – can serve a critical role in promoting digital access and literacy across disenfranchised patient populations. But because these roles are often funded on limited timelines, and without support for necessary training and professional development to ensure culturally safe patient experiences, they are often not effective.
There are, however, existing models that could be developed into best practices (for example, bilingual clinical outreach teams that offer education in local public housing sites). But greater investment in needed to develop and expand such supports; MHA is advocating for such funding through the state budget process.
Housing Affects Health, and Mass. Has an Old Housing Stock
MHA is supporting the Healthy Homes Initiative, which seeks American Rescue Plan Act (ARPA) funding to help rehabilitate old housing stock in the commonwealth to make it safer and healthier. More than 70% of homes in Massachusetts were constructed before lead paint was banned in 1978. Substandard homes also can have other hazards, including poor indoor air quality caused by mold, dust, second-hand smoke; poor ventilation; infestation; and structural inadequacies. All of these conditions affect health, and the people most affected are usually those in communities of color, rural towns, “Gateway Cities,” and other places that COVID-19 hit hard. Black children are nearly 2.5 times more likely to have lead poisoning than white children, and 17% of children living in a household with income of less than $25,000 suffered from asthma, which is often attributable to poor living conditions.
The Healthy Homes Initiative calls on the Massachusetts legislature to invest $100 million in federal ARPA funds to provide grants and low-cost deferred-payment loans to income-eligible homeowners and landlords so they can make necessary repairs.
A Reminder: The Pandemic Battle is Not Over
“While the nation remains weary and is eager to move past this pandemic, the virus continues to evolve and pose a threat to our nation’s health care system. The recent surge of cases and hospitalizations abroad fueled by the Omicron variant known as BA.2 serves as a critical warning: The battle is not over, and hospitals and health systems continue to need resources and flexibilities to care for patients and protect communities.”
That’s what the American Hospital Association (AHA) wrote to Congressional leaders last week, requesting additional financial relief. AHA detailed how Provider Relief Funds have been distributed to date and noted that “shockingly, no distributions were made for expenses related to the Delta or Omicron variant surges, despite 49% of COVID-19 admissions occurring during these two surges resulting in steep increases in cases, hospitalizations, and deaths. The lack of PRF dollars to address issues wrought by these surges has left many hospitals facing overwhelming financial and operational challenges.”
AHA called for additional PRF dollars, extending Medicare sequester relief, and a delay in recoupment of the Medicare accelerated and advance payments made during the pandemic.
DMH’s Hospital-Community Provider Program Shows Results
As MHA has reported to its membership previously, the Department of Mental Health (DMH) is interested in partnering with hospitals and matching them with community providers to help relieve the behavioral health boarding crisis (see below) by expanding hospital diversion programs. The outreach benefits people of all ages admitted to emergency departments, who have been assessed as safe to return to their homes or community living arrangement. The programs are paid through contracts with DMH and are open to all youth, family, and adults with or without authorization for other DMH services. They are also available for patients with all types of health insurance coverage. Last week, WCVB-TV ran a story that describes the benefits of the DMH-funded programs, which coordinate with EDs for in-home wrap-around services from community-based providers. Those interested in establishing these programs can contact DMH’s Project Lead, Jay Tallman, at firstname.lastname@example.org or (617) 680-3579.